Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Demographic change is fast becoming one of the most globally significant trends of the 21st century. Declining fertility rates and rising life expectancy -- two of the patterns triggering demographic change -- will cause vast socioeconomic strains, especially in the Asia-Pacific region, which has some of the world's most populous countries. Stanford health researcher Karen Eggleston says comparison and cross-collaboration are needed to induce creative solutions.

In an interview with the Office of International Affairs, Eggleston discusses her research approaches and partnerships in the study of healthcare systems and health policy in the Asia-Pacific region. She leads a multiyear research initative that examines comparative policy responses to demographic change in East Asia. Eggleston says the goal is to help move global health policy to a place where everyone has an "equal opportunity for a healthier and longer life."

The Q&A may be viewed in full by clicking here.

Analyzing demographic change in China, Japan and South Korea is the focus of the book Aging Asiaan outcome of a conference between the Walter H. Shorenstein Asia-Pacific Research Center and the Stanford Center on Longevity.

Eggleston also coedited a special issue of the Journal of the Economics of Ageing with David Bloom, a professor at Harvard University, looking at a range of economic issues related to population change in China and India.

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Karen Eggleston (left) confers with a healthcare worker at a primary care clinic in Hangzhou, China. | Robin Yao
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For Matthew Kohrman and his students, the war against tobacco needs a new communications strategy.

After all, he noted, three times as many cigarettes are currently manufactured and sold worldwide than were in the 1960s. And the global cigarette industry is the greatest cause of preventable death on the planet today.

That’s why the Stanford associate professor of anthropology decided to teach an introductory seminar this spring, Anthro 182N, titled Smoke and Mirrors in Global Health. Kohrman led his 10 students on a journey into the “strange optics” that the global tobacco industry uses – and what to do about them.

As noted in the syllabus, “entrenched challenges” to global health require society to develop “new methods” to communicate the real truth about tobacco.

Just what are those “new methods?” At the culmination of the class, the students presented some variations on that theme. Their end-of-the-quarter projects were web-based efforts profiling various features of global tobacco. They included exposés on how academicians in China assist the industry in that country, humorous parodies and critiques of Philip Morris, and flawed approaches to tobacco control in South Korea.

They tackled big-picture questions, Kohrman said. For example, they asked what exactly constitutes cigarette manufacturing and how new strategies could help slow the spread of tobacco-related diseases worldwide.

Kohrman, the director of Stanford’s Cigarette Citadels project, envisioned his class as a way for students to offer some thought-provoking and original ideas grounded in solid data. After viewing the student projects, he was astounded – and proud.

“My overall impression has been a feeling of awe,” he said. “Mostly freshmen and sophomores, the students who enrolled in this new course quickly synthesized complex intellectual concepts introduced early in the quarter, conceived their own innovative project ideas, collected relevant data, generously worked with each other, designed apt strategies for evocatively visualizing their messages, and chose and implemented strong interactive media tools – most of which were utterly new to me.”

One of those students was Minkee Sohn, a communication major, who created a video, “Fresh Recruits,” to highlight what he believes is the hypocrisy in the language of some cigarette manufacturers’ recruitment efforts.

“While cigarette manufacturers,” Sohn said, “often frame smoking as an act of free choice, that choice is just an illusion. Free choice is denied to people in all stages of cigarette manufacturing and consumption.”

For example, he explained that children in the African country of Malawi are coerced to work with their families in tobacco fields. “It’s deeply disturbing to hear companies associate freedom with high-paying jobs in cigarette manufacturing.”

For biology major Annabel Chen, the most important thing she learned was to analyze information skeptically. “Industries like big tobacco have influences in unexpected places, so you always need to do sleuthing to find out the truth,” she said.

She chose to examine the links between tobacco and academic research in China. “Seeing as China is the biggest tobacco market in the world, this was a problem we needed to address.”

Kohrman appreciates how students like Sohn and Chen were willing to try an experimental course, never taught before, and which for many was outside of their comfort zone. He said the course will be taught again in 2015-16.

“Looking back, it was the perfect-size group for all the work and one-on-one teaching we did,” he said.

The course was a classic collaboration, according to Kohrman, who also credits Claudia Engel, a lecturer in the Anthropology Department who helped with the technology and his own experiences mentoring undergraduate research, all of which proved instrumental to designing Smoke and Mirrors in Global Health.

“It was a great success today,” he said after seeing the student projects on the last day of class. Tom Glynn, a top adviser to the American Cancer Society, was on hand to see the presentations.

Kohrman added, “Students got tremendous feedback, and there was lots of enthusiasm about how this experimental course unfolded.”

Clifton Parker is a writer for the Stanford News Service.

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Smoking area sign. | Flickr/Shizhao
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The United Nations has thus far fulfilled its charter to prevent a third world war, but with 60 million refugees, continued bloodshed with unresolved civil conflicts and terrorism spreading like cancer, the world's leading peacekeeping organization must spearhead global action, U.N. Secretary-General Ban Ki-moon said Friday at Stanford on the 70th anniversary of the international organization.

Ban, the U.N.'s eighth secretary-general, did not rest on any laurels during his speech at a public event sponsored by the Walter H. Shorenstein Asia-Pacific Research Center (APARC). "I humbly accept criticism that the U.N. is not doing enough," he said. 

However, the situation could have been worse if not for the United Nations, he continued. "Without peacekeepers, or without the U.N.'s continued humanitarian assistance and advocacy of human rights, I'm afraid to tell you that this world would have been poorer, more dangerous and even bloodier without the United Nations."

Ban's visit to Stanford – his second to the university in less than three years – was part of a trip to the Bay Area to commemorate the signing of the U.N. charter. In 1945, representatives from 50 nations gathered in San Francisco to create the United Nations – an international organization aimed at saving future generations from the "scourge of war."

Today, the United Nations has grown to 193 member nations. Its challenges – from climate change and poverty to civil wars and terrorism – have never been greater, Ban said.

"This is a critical year; 2015 is a year of global action," he said. "The U.N. cannot do it alone. We need strong solidarity among government, business communities and civil societies, from each and every citizen."

The fact that so many young people around the globe are drawn to violent narratives is worrisome, Ban said. "Violent terrorism is spreading like cancer around the world."

The rise in terrorist activities stems from "a failure of leadership," he said. That's why the United Nations needs to develop a comprehensive plan of action to address extremism, he maintained.

The U.N.'s 70th anniversary coincidentally fell on a momentous day of tragedy and celebration around the world. Dozens were killed when terrorists launched horrific attacks across three continents – in France, Tunisia and Kuwait – fueling anger, sadness and fear of more violence.

But in the United States, celebrations rang out in response to a landmark U.S. Supreme Court ruling that legalizes same-sex marriages nationwide.

Ban, who has long advocated for equality and last year pushed the United Nations to recognize same-sex marriages of its staff, drew a round of applause when he heralded the court ruling as "a great step forward for human rights."

The June 26 event was co-sponsored by Shorenstein APARC and the Freeman Spogli Institute for International Studies at Stanford University, with promotional co-sponsors Asia Society, Asia Foundation and the World Affairs Council of Northern California

May Wong is a freelance writer for the Stanford News Service.

Coverage and related multimedia links:

Remarks at Stanford University by Ban Ki-moon (U.N. News Centre, 6/26/15)

Photos of Ban Ki-moon at Stanford University (U.N. Photo, 6/26/15)

At Stanford University, Ban says U.N. ready to build a better future for all (U.N. News Centre, 6/27/2015)

U.N. Secretary-General Ban Ki-moon welcomes growing engagement of India, China (NDTV, 6/27/2015)

U.N. Secretary-General Ban Ki-moon speaks at Stanford, celebrates U.N.'s 70th anniversary (Stanford Daily, 6/29/15)

Hoover archival photographs featured at lecture delivered by U.N. Secretary-General Ban Ki-moon (Hoover Institution, 6/29/2015)

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Ban Ki-moon, the eighth secretary-general of the United Nations, urged the audience to see 2015 as a year of global action. | UN/Mark Garten
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This workshop will focus on the importance of community health services and primary health care reform in China and discuss what clinicians and policymakers are doing to improve health outcomes. With researchers and clinicians from China and the US, we will discuss the policy challenges to improving China’s health care system at the community and grassroots level. Key themes include China’s local experiences, showcasing innovations in Hangzhou, as well as the question of how the private sector might play a role in strengthening community health in China. The Asia Health Policy Program thanks ACON Biotechnology for sponsoring this event.

http://aparc.fsi.stanford.edu/research/innovations-primary-care

 

Stanford Center at Peking University

Beijing, China

Jean Oi Stanford University
Liang Wannian China Health and Family Planning Commission
Feng Lin Chairman, ACON Biotechnology

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
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Senior Fellow at the Freeman Spogli Institute for International Studies
Professor, by courtesy, Health Policy
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director, Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
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Stanford University
Jiangnan Cai Director of Health Management and Policy Research, CEIBS
Jiaji Wang Guangzhou School of Public Health
Hai Fang Peking University School of Public Health
Min Yu Deputy - Director, Zhejiang CDC
Zhiling Zhou Deputy - Director, Hangzhou Health and Family Planning Commission
Yan Ma Deputy - Director, Shangcheng District Government
Randall Stafford Program Director, Program on Prevention Outcomes and Practices, Stanford University
Hengjin Dong Zhejiang University
Shuling Chen Zhejiang University
Zhihong Hu Director, Xiao Ying Xiang Community Health Service Center
Fang Qian Director, Si Ji Qing Community Health Service Center
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This is a time at which the global movement for universal health coverage (UHC) is under intense review.  As an isolated country which recently opened up to the world, Myanmar has endorsed the goal of achieving UHC by 2030. However, current evidence has shown that there will be significant challenges for Myanmar to achieve this target.  The Myanmar health system comprises a pluralistic mix of public and private systems both in financing and provision. It was ranked the second worst in terms of ‘overall health system performance’ by the WHO in 2000. According to World Bank (2012), the country’s out-of-pocket payment burden is one of the highest in the world, at 81% of total health expenditures, resulting in high levels of catastrophic health expenditure. About three-quarters of Myanmar’s citizens, including the poorest and most marginalized communities, find themselves with very limited access to essential health services. And too many of these same populations suffer a further burden of being pushed, or kept, in poverty because they have to pay for their health care. Recognizing the fragility of its health system, Myanmar launched some transformations in the health sector in 2011. The most significant changes were increasing the health budget four-fold since 2011, launching some health insurance programs in some areas, starting to collaborate with a diversity of actors in the health sector, and major structural changes in the Ministry of Health, Myanmar. This colloquium will reflect upon these transformations and discuss how the changes will shape Myanmar’s future health system, drawing upon comparisons with health reforms in other South East Asian countries.

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Phyu Phyu Thin Zaw is currently a visiting scholar at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC). Her research interests are reproductive health, equity, health policies and gender issues.  

After receiving her MBBS degree from the University of Medicine (Mandalay), Phyu Phyu worked for two years at a public hospital. In 2009, she became an active researcher at the Department of Medical Research (Upper Myanmar). As a researcher, she participated in various clinical and public health researches and presented papers at national and international conferences. She was also actively involved in the welfare of underprivileged groups in Myanmar. She earned her PhD in Epidemiology from the Prince of Songkla University, Thailand in 2013. After her PhD, she continued her work at DMR (Upper Myanmar) as a research officer as well as a member of the secretariat of the Academic Committee. She was also as a field supervisor in two national surveys on HIV and RH commodities and services in Myanmar. She has also published journal articles on equity, gender differences and RH services utilization among the poor.

At APARC, Phyu Phyu will study the current trends of Myanmar health policies in general, as well as the specific sex education programs of the country. She will investigate how Myanmar/Burmese culture affects the objectives of the current sex education programs at schools based on the perceptions of adolescent students, teachers and parents.

 

The Philippines Conference Room

Encina Hall 3rd Floor Central

616 Serra Street

Stanford, CA 94305

Phyu Phyu Thin Zaw 2014-2015 Walter H. Shorenstein Asia-Pacific Research Center Visiting Scholar
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China has a relatively weak primary healthcare system as well as the highest absolute disease burden of diabetes in the world, accounting for almost one in three diabetes patients globally. An estimated 74.2% of the 114 million Chinese patients with diabetes are untreated. Extending treatment will add a heavy burden on the health care system. As the most developed Chinese city that spends a modest 5.1% GDP on health with excellent outcomes, Hong Kong may serve as a cost-effective model for strengthening primary  care for chronic disease management, with diabetes care as an example.

In this seminar, Professor Leung will discuss the health system in Hong Kong, the importance of primary care, and recent research assessing the ‘value for money’ of care for all 631,469 patients with diabetes who attended the public sector in Hong Kong between 2006 and 2013.  He argues that the publicly funded and provided integrated model of Hong Kong may serve as a useful value-for-money reference as mainland China scales up to address the national epidemic of chronic disease like diabetes.  

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Gabriel Leung became the fortieth Dean of the Li Ka Shing Faculty of Medicine in August 2013. Leung, a clinician and a respected public health authority, concurrently holds the Chair of Public Health Medicine. Previously he was Professor and Head of Community Medicine and served as Hong Kong’s first Under Secretary for Food and Health and fifth Director of the Chief Executive's Office in government.

Leung specialises in the field of public health medicine, a statutorily accredited specialty that covers the full range of public health sciences and their constituent disciplines.

Within the broad scope of public health medicine, his major interests revolve around topics that 1) have major population health impact locally, 2) where Hong Kong is a reliable and unique epidemiologic sentinel for mainland China, or 3) where Hong Kong is particularly endowed and best placed to address the fundamental science at hand. As such his research crosses the traditional boundaries of individual disciplines or fields of enquiry.

Philippines Conference Room

Encina Hall 3rd. Floor Central

616 Serra Street,

Stanford, CA 94305

Gabriel M. Leung Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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The Asian Liver Center and the Asia Health Policy Program joint event.

Current Status of the Health System in Mongolia
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Asian Liver Center

780 Welch Road, CJ 130

Palo Alto, CA

Enkhbold Sereenen Deputy Director, National Center for Communicable Disease, Ministry of Health, Mongolia
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Anne Mills will speak about primary healthcare and the private sector in low- and middle-income Countries, drawing from her wide-ranging expertise and careful empirical evaluation of health policies in a range of countries in Asia, Africa, and other parts of the developing world. Linking themes of good health at low cost and equitable paths toward universal coverage, Professor Mills will argue how policymakers might best strengthen healthcare systems in the Asia-Pacific region, including the opportunities for health and efficiency improvements and the opportunity costs of continuing hospital-centric delivery systems. Professor Mill embodies a distinctive ability to combine broad thinking on the role of primary care with specific examples of how to harness the private sector toward public health objectives, an inter-linked theme the Asia Health Policy Program’s colloquium series and policy research. 

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Dame Anne Mills DCMGCBEFRS  Vice Director and Professor of Health Economics and Policy at the London School of Hygiene and Tropical Medicine. In 2014 she became a Fellow of the Royal Society and was made a Dame in the 2015 New Year's Honors. Her main research interests are: (1) issues concerned with the financing and organization of health care in low and middle income countries, including the impact on demand, utilization, equity and efficiency, and the private health sector; (2) the economics of tropical disease control; and (3) how to encourage the use of economic thinking and analysis in decision making. Professor Mills has been active in making economic evaluation techniques accessible to a non-specialist audience, as well as initiatives to build capacity in health economics. She chaired the Board of the Alliance for Health Policy and Systems Research, based in WHO; was a member of the Commission on Macroeconomics and Health; and co-chaired Working Group 1 of the High Level Taskforce on Innovative International Financing for Health Systems.  Dr. Mills was President of the International Health Economics Association for 2012-13, and is currently a Board member of Health Systems Global.

Philippines Conference Room

Encina Hall, 3rd Floor Central

616 Serra Street,

Stanford, CA 94305

Anne Mills Vice Director and Professor of Health Economics and Policy London School of Hygiene and Tropical Medicine
Seminars
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